Vitamin D is an important immune modulator and is associated with susceptibility to infection. However, past studies have reported inconsistent results regarding the association between vitamin D deficiency and mortality in patients with sepsis, and early-stage data regarding septic shock are limited. This study aimed to determine the relationship between vitamin D deficiency on admission to the emergency department (ED) and mortality in patients with septic shock.
We analyzed prospectively collected data on adult patients with septic shock who were treated with protocol-driven resuscitation bundle therapy in the ED between September 2019 and February 2021. Septic shock was defined by the sepsis-3 definition and vitamin D deficiency was defined as a 25-hydroxyvitamin D <20 ng/ml. The primary outcome was 30-day mortality.
A total of 302 patients were included, 236 (78.1%) patients had vitamin D deficiency; it was significantly higher in non-survivors than in survivors (89.3% vs. 73.9%, P = 0.004). Mortality was higher in vitamin D deficient patients than in non-deficient patients (31.8% vs. 13.6%, P = 0.004). In multivariate analysis, vitamin D deficiency (odds ratio [OR], 2.43; 95 % confidence interval [CI], 1.03–5.74), hyperlactatemia (OR, 3.65; 95 % CI, 1.95–6.83), Sequential Organ Failure Assessment scores (OR, 1.22; 95% CI, 1.09–1.36), and albumin levels (OR, 0.39; 95% CI, 0.21–0.73) were significantly associated with 30-day mortality.
Vitamin D deficiency was prevalent in patients with septic shock visiting the ED and was associated with mortality.
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- Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.Read Online: Critical Care Medicine| Society of Critical Care Medicine. 2001; 29: 1303-1310
- Sepsis and septic shock: guideline-based management.Cleve Clin J Med. 2020; 87: 53-64
- The surviving sepsis campaign bundle: 2018 update.Intensive Care Med. 2018; 44: 925-928
- Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis.J Transl Med. 2009; 7: 28
- Vitamin D and cardiovascular disorders.Osteoporos Int. 2019; : 1-15
- Prospective study of predictors of vitamin D status and cancer incidence and mortality in men.J Natl Cancer Inst. 2006; 98: 451-459
- Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study.Lancet North Am Ed. 2001; 358: 1500-1503
- Low vitamin D levels predict stroke in patients referred to coronary angiography.Stroke. 2008; 39: 2611-2613
- Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study.Intensive Care Med. 2010; 36: 1609-1611
- Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill.Crit Care Med. 2011; 39: 671
- Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis.Critical care. 2014; 18: 1-8
- Association between vitamin D deficiency and mortality in critically ill adult patients: a meta-analysis of cohort studies.Critical care. 2014; 18: 684
- Vitamin D Supplementation in Influenza and COVID-19 Infections Comment on:“Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths” Nutrients 2020, 12 (4), 988.Nutrients. 2020; 12: 1626
- Inflammation and vitamin D: the infection connection.Inflamm Res. 2014; 63: 803-819
- Immunoregulation by 1, 25-dihydroxyvitamin D3: basic concepts.J Steroid Biochem Mol Biol. 2005; 97: 93-101
- Regulation of immune function by vitamin D and its use in diseases of immunity.Endocrinol Metabol Clin. 2017; 46: 1061-1094
- The third international consensus definitions for sepsis and septic shock (Sepsis-3).JAMA. 2016; 315: 801-810
- The SOFA (Sepsis-related Organ Failure Assessment) score describes organ dysfunction/failure.Springer-Verlag, 1996
- Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.J Clinic Endocrinol Metabol. 2011; 96: 1911-1930
- Increases in pre-hospitalization serum 25 (OH) D concentrations are associated with improved 30-day mortality after hospital admission: a cohort study.Clin Nutr. 2016; 35: 514-521
- Vitamin D status and its association with season, hospital and sepsis mortality in critical illness.Critic Care. 2014; 18: R47
- Prevalence of vitamin D deficiency in critically ill patients and its influence on outcome: experience from a tertiary care centre in North India (an observational study).J Intens Care. 2013; 1: 14
- Vitamin D deficiency in critically ill patients.N Engl J Med. 2009; 360: 1912-1914
- Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill.Crit Care Med. 2014; 42: 97-107
- Vitamin D deficiency-a potential risk factor for sepsis development, correlation with inflammatory markers, SOFA score and higher early mortality risk in sepsis.Bratisl Lek Listy. 2019; 120: 284-290
- The Correlation between serum level of Vitamin D and outcome of sepsis patients; a cross-sectional study.Arch Acad Emerg Med. 2019; 7
- 25 (OH) D and 1, 25 (OH) D vitamin D fails to predict sepsis and mortality in a prospective cohort study.Sci Rep. 2017; 7: 1-10
- Vitamin D deficiency is associated with mortality in the medical intensive care unit.Critic Care. 2011; 15: R292
- Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study.Intensive Care Med. 2002; 28: 108-121
- Vitamin D insufficiency and sepsis severity in emergency department patients with suspected infection.Acad Emerg Med. 2011; 18: 551-554
- Vitamin D in critically ill patients.Anaesthesiol Intens Ther. 2016; 48: 201-207
- Vitamin D: a novel player in endothelial function and dysfunction.Arch Medic Sci. 2012; 8: 4
- The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome.Blood. 2003; 101: 3765-3777
- Infections and the compromised immune status in the chronically critically ill patient: prevention strategies.Respir Care. 2012; 57: 979-992
- Vitamin D deficiency is independently associated with mortality among critically ill patients.Clinics. 2015; 70: 326-332
- Seasonal variation in the epidemiology of sepsis.Crit Care Med. 2007; 35: 410-415
- Serum concentrations of vitamin D and organ dysfunction in patients with severe sepsis and septic shock.Rev Bras Terapia Intens. 2015; 27: 376-382
- Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial.JAMA. 2014; 312: 1520-1530
- Effect of vitamin D3 on the severity and prognosis of patients with sepsis: a prospective randomized double-blind placebo study.Zhonghua wei zhong bing ji jiu yi xue. 2017; 29: 106-110
Published online: October 17, 2022
Accepted: October 13, 2022
Received: February 15, 2021
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.